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ePaper created 2016-03-02, 11:52:18 | version 1.38.0
By Paresh B. Patel, DDS n When a patient presents with an edentulous arch or terminal denti- tion, implant treatment can be pro- vided that improves not only form and function but also quality of life. For patients desiring better chew- ing capability, stability, esthetics and comfort than a traditional denture can offer, both removable and fixed implant restorations are superior alternatives. As evidenced by the case that fol- lows, in which one arch is restored with an implant overdenture and the other with a BruxZir® Full-Arch Implant Prosthesis, practitioners today have a great deal of clinical flexibility. Case presentation A47-year-oldmalepresentedwithter- minal dentition in both arches result- ing from periodontal disease and severe caries (Fig. 1). He had saved up enough money for a fixed implant res- toration for his upper arch, for which he desired the most stable, functional prosthesis possible. Whilehecouldn’taffordsuchares- toration for both arches, he wanted a retentive appliance for his mandible. The patient accepted a treatment plan in which his maxilla would be restored with a BruxZir Full-Arch Implant Prosthesis and his mandible with an Inclusive® Locator Implant Overdenture. At the surgical appointment, the patient’s remaining teeth were removed. Four Inclusive Tapered Implants (Glidewell Direct; Irvine, Calif.) were placed in each arch. Inclusive Multi-Unit Abutments (Glidewell Direct) were attached to the maxillary implants, correcting for their divergent angulation. Having achieved sufficient pri- mary stability, the implants placed in the patient’s maxilla were loaded with an immediate denture, satisfy- ing the patient’s desire to leave the surgical appointment with a fixed maxillary prosthesis in place. A lower immediate denture was modified and relined to seat over the mandibular implants during healing. The final radiograph taken after seat- ing the temporary appliances con- firmed excellent positioning of the implants (Fig. 2). Three and a half months later, VPS impressions were taken. The restora- tive protocol for both prostheses included wax rims and setups. After final approval of the wax setups, a custom-tray final impression was taken of the maxillary arch to ensure the prosthetic design was accurate before milling the final restoration from monolithic zirconia. The lab fabricated the final lower appliance, including denture caps that provide retention and stabi- lize the prosthesis. Based on the custom-tray final impression, the maxillary prosthesis was designed usingadvanceddentalCADsoftware, and a provisional implant prosthesis was milled from PMMA. At the following appointment, the Inclusive Locator Implant Overden- ture was seated and checked for proper fit and function. Then the provisional implant prosthesis was screwed into place, and its teeth posi- tioning, function and esthetics were verified. With both appliances in place, the interocclusal relationship was checked and minor adjustments made. The patient wore the provi- sional full-arch implant prosthesis for a trial period of two weeks to ver- ify the accuracy of the design before it was returned to the lab. The final BruxZir Full-Arch Implant Prosthesis was digitally fab- ricated with precision and, as an exact reproduction of the test-driven provisional, fit perfectly and offered the esthetics and function the patient had come to expect (Fig. 3). The final restoration effectively addressed the unique circumstances of the case, providing the most dura- ble, stable prosthesis possible for his upper and a lower restoration that greatly improves prosthetic reten- tion. exhibitors 16 Yankee Dental Congress — January 29, 2016 Fixed and removable implant restorations: A solution for every arch 5 Fig. 3: The final BruxZir Full-Arch Implant Prosthesis completes a dramatic oral reconstruction for a patient who presented with terminal dentition, restoring form, function and quality of life. 5 Fig. 1: Preoperative condition of the patient. Note the high lip line, severe cervical decay present on the patient’s remaining teeth and lack of gingival support. (Photos/Provided by Glidewell Laboratories) 5 Fig. 2: Postoperative panoramic radiograph illustrates All-on-4 configuration of maxillary implants and axial placement of the mandibular implants, which would facilitate a passive fit of the lower overdenture. Here at Yankee To learn more about the BruxZir Full-Arch Implant Prosthesis and the Inclusive Locator Implant Overden- ture, stop by the Glidewell Laborato- ries booth, No. 1600.